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NDT Advance Access published online on June 4, 2006
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfl216
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© The Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Received November 17, 2005
Accepted March 29, 2006

Original Article

Outcome of kidneys in patients treated for vesicoureteral reflux (VUR) during childhood

Tuija Lahdes-Vasama 1 *, Kaija Niskanen 2, and Kai Rönnholm 3

1 Paediatric Research Centre, Tampere University, Division of Paediatric Surgery, Tampere University Hospital, Finland
2 Helsinki Medical Imaging Centre, Helsinki University Central Hospital, Finland
3 Division of Paediatric Nephrology Hospital for Children and Adolescents, Helsinki University Central Hospital, Finland

* To whom correspondence should be addressed.
Tuija Lahdes-Vasama, E-mail: tuija.lahdes-vasama{at}pshp.fi



  Abstract

Background. Outcome of renal function and blood pressure (BP) at early middle age was clarified in patients treated for vesicoureteral reflux (VUR) during childhood.

Methods. Information of renal function was available from 147 (55%) of 267 patients treated for non-obstructive VUR of any grade. Twelve patients had died of kidney-related conditions and eight had gone into terminal uraemia. A total of 127 patients participated in the study.

Results. The mean age of the participants was 41 years. No signs of renal scars were detected by ultrasound examination in 53 (42%) subjects. Unilateral scarring was seen in 44 (35%) and bilateral in 30 (24%) subjects. Glomerular filtration rate (GFR) showed moderate or severe renal insufficiency in four (3%) participants, all with bilateral scars. Normal GFR was found in one-third of the patients. Twenty-five (83%) subjects with bilateral scars and 60 (62%) of the other participants had abnormal GFR values (P < 0.05). Proteinuria was found in 12 (9%) and albuminuria in 30 (24%) participants. Hypertension was diagnosed earlier in 14 (11%) patients, eight having bilateral scarring (P < 0.01). Diastolic BP was significantly lower in subjects without scars compared with those having scars in one or both kidneys (P < 0.05).

Conclusions. Renal function was slightly lowered in more than half of the participants. Findings of the participants with unilateral scarring or unscarred kidneys were similar, except for the increased tendency for hypertension in subjects with scars. A total of 83% of the patients with bilateral kidney scars had lowered kidney function, a quarter presented with proteinuria and a half with hypertension. Long-term follow-up for all the patients with earlier VUR is emphasized.

Keywords: hypertension; kidney scars; long-term; renal function; vesicoureteral reflux.
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